Infant Illnesses – Congenital Muscular Torticollis

Congenital muscular torticollis (CMT), commonly called ‘wryneck’, is a condition in which a baby’s neck muscle is shortened, causing the head to tilt to one side. This is usually present at birth and its lifespan depends on the underlying cause. CMT usually affects 1 in 10 babies.

Why does CMT occur?

CMT may occur for a number of reasons. Difficult births such as delivering a large baby or breech deliveries are some of the causes that a baby could be born with CMT. Diagnosis is usually made by the paediatrician within 2 to 3 months after the birth. During delivery if the neck muscle is stretched or injured, fibrosis or scar tissue is developed. This causes the muscle to shorten or tighten and hence causing the baby’s head to tilt to the side. Defects in the development of the neck muscle or abnormal fetal positions can also cause CMT. CMT appears to be more common in males than females. Studies have shown that 10% of babies with CMT have had family members born with CMT.

How is CMT traced?

A pediatrician is able to trace CMT with the aid of x-rays and ultrasound examinations. The x-rays assist in tracing abnormalities in the neck and shoulder bones. Usually, x-rays are opted for when the cause of CMT is a congenital malformation of the cervical spine. Some children with CMT will also have other musculoskeletal problems, and thus, x-rays of other parts of the body may also be required. To differentiate CMT from other neck pathologies, ultrasonography might be first carried out. Once CMT has been identified, x-rays and ultrasound will be chosen based on the severity of CMT.

Can CMT be prevented? What are the treatments that will be offered for CMT?

CMT may not be prevented but it can be treated. Treatment is usually conducted through either medications or exercising of the muscles, depending on the severity of the condition. Usually parents will be referred to physical therapists to learn the exercises that are to be used on the babies in order to exercise the muscles. These exercises include turning and side bending the child’s head to stretch the muscle. Most of the time, the neck mass may enlarge during a baby’s first month but gradually has the tendency to decrease and eventually disappear. At times, surgery is also one of the considerations to correct the shortened muscle. Also, the child’s age, medical history and the parent’s opinion would be considered before any type of treatment begins.

Are there any effects to the treatments?

Most infants, after treatment, have no future problems. However, a small number may develop an abnormality of their ability to tilt the head, a difference in the size and shape of the two sides of the neck and at times perhaps even an extremely slight degree of scoliosis. The risk of these complications does not appear to be affect by the different kinds of treatments used. However, there are problems if CMT is left untreated. These problems, sometimes can lapse into long term problems such as loss of motion of the neck, untreated inflammatory disease and at times, even loss of function in the child. Although successful operations have been carried out on children even up to ten years of age, it is always better to detect CMT early and treat it.

When should I consult my pediatrician?

Although symptoms of CMT vary from child to child, it is best to consult your pediatrician when you observe your child tilting his/ her head to one side or his/her chin appears to be turning towards the opposite side. After all, the faster it is detected, the better and more efficiently can treatment be carried out.